To review the existing literature on depression among elderly arising from India. Search was carried out using PubMed, Google Scholar, Google, and Medknow search engines to identify the relevant studies. Most of the literatures that are available are in terms of prevalence of depression. Community-based studies involving 70 to 7,150 elderly subjects report prevalence rate varying from 8.9% to 62.16%. Clinic-based studies involving 50 to 5,260 participants report prevalence rates ranging from 42.4% to 72%. Studies have reported depression to be more common among females. Other demographic factors that have been associated with depression among elderly include being unmarried, divorced or widowed elderly, residing in rural locality, being illiterate, increasing age, lower socioeconomic status, and unemployment. Depression has also been shown to be associated with various psychosocial factors, lifestyle and dietary factors, and presence of chronic physical illness. There are limited data on various therapeutic interventions. Available data suggest usefulness of pranayam, cognitive behavior therapy, and electroconvulsive therapy. The review of data suggests that prevalence of depression among elderly in India is high. However, there is lack of data on symptom profile and limited data is available on various therapeutic interventions for the management of depression in elderly from India. There is urgent need to conduct large multicentric studies to fill this void in research.

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Aim of the Study: This study aimed to evaluate the prevalence of loneliness and its relationship with social connectedness and depression in elderly. Additional aims were to evaluate the demographic and clinical factors associated with loneliness and social connectedness in elderly patients with depression. Methodology: The study sample comprised 488 elderly patients (age ≥60 years) with depression recruited across 8 centers. These patients were evaluated on Geriatric Depression Scale (GDS-30), Generalized Anxiety Disorder-7 Scale (GAD-7), Patient Health Questionnaire-15 (PHQ-15) Scale, Columbia Suicide Severity Rating Scale, UCLA Loneliness Scale (LS), and Revised Social Connectedness Scale. Results: About three-fourth (77.3%) of the entire sample reported the presence of loneliness. With respect to specific loneliness symptom, 62.5% reported lack of companionship, 58.7% reported being left out in life, and 56.5% of the individuals reported felt isolated from others. No gender differences were noted in the prevalence of any loneliness symptom. Higher loneliness scores had significant positive correlation with severity of depression, anxiety, and somatic symptoms as assessed by GDS-30, PHQ-15, and GAD-7, respectively, in individuals of both the genders. Higher social connectedness was associated with higher level of anxiety and lower loneliness in females only. Being currently single, older age, longer duration of illness, presence of family history of mental illness, presence of comorbid physical illness, and absence of substance abuse were associated with higher loneliness. With regard to suicidality, higher loneliness was associated with nonspecific active suicidal thoughts, active suicidal ideations with and without intent, nonsuicidal behavior, and higher intensity of suicidal ideations. Conclusions: About three-fourth of the elderly patients with depression also have associated loneliness. Loneliness is associated with higher severity of depression, anxiety, and somatic symptoms. Severity of depression is associated with loneliness but not with social connectedness. Lower social connectedness among elderly females with depression is associated with higher loneliness, but this is not true for elderly males with depression.

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The present review aims to throw some light on the various aspects of sexuality in older adults and the challenges faced by medical professionals working in this area. Keyword searches using the terms "sexuality," "sexual dysfunction," "geriatric," "old age," and others in combination were carried out on PubMed, Google Scholar, and the Cochrane Database of Systematic Reviews. Relevant clinical trials, case studies, and review papers were selected. This was further supplemented with the clinical experience of the authors, who work with older patients in a psychiatric outpatient setting with a dedicated sexual disorders clinic. Sexuality is a lifelong phenomenon and its expression a basic human right across all ages. However, the construct of normalcy for sex in aging is blurred, with agism playing a distinct role. Older adults face much stigma when expressing sexual desires or concerns, both from their own families and the health-care system. Sexual dysfunctions due to comorbid medical illnesses and medications are often treatable. Evidence-based treatments for sexual dysfunction in the elderly, lesbian, gay, bisexual, transgender, and queer, and other orientations are especially underrepresented in research; available research has several limitations. Sexuality in people with dementia and sexual rights in nursing homes are gray areas. Medical training, treatment guidelines, and health-care facilities all need to be stepped up in terms of awareness and quality of care provided to the elderly with concerns related to sexuality.

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Age and agism are significant vulnerabilities for the coronavirus disease 2019 (COVID-19). While the number of cases and fatalities rises throughout the globe, the elderly are prone both to the physiological and psychosocial aftermaths of the infection. As the focus on management is predominantly directed toward precautionary measures and searching for a biological cure, the mental well-being of this vulnerable population is unfortunately neglected. Besides being prone to isolation, loneliness, stress, grief, depression, and anxiety during the lockdown, the seniors are also victims of stigma, prejudice, and abuse, stemming from agism. Substance abuse-related complications and cognitive disorders are added concerns. Elder abuse in every form has particularly been concerning during the present pandemic. Especially those staying alone, those with sensory or cognitive impairment, and those institutionalized are at a greater risk. Considering the increasing number of aging population, such biological disasters can have notable acute and long-term consequences on overall health and well-being of the seniors, if not adequately cared for. A holistic care based on biopsychosocial model needs to be in force for elderly mental health care during the pandemics, supplemented by research to shape policies. Keeping this in background, the advocacy review glances at the unique challenges that the older adults face during COVID-19 with special focus on psychosocial well-being, agism, and abuse. It also highlights the important facets for elderly care and abuse prevention during such crises.

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The population of elderly substance users is gradually increasing over the years in India due to the aging population and changing demographics. Hence, clinicians are likely to encounter a larger proportion of elderly substance users with time. This narrative review aims to provide an overview of the substance use disorders in the elderly with a focus on the Indian population. The epidemiology of substance use disorders in the elderly is discussed, as is the unique features of specific substances of use in this population. The overlay of medical comorbidities in the elderly substance users is highlighted. This is followed by the discussion of the key issues in the assessment and management of elderly substance users. The directions of future research in this field are subsequently highlighted.

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Aims and Objectives: To study loneliness, depression and coping mechanism and the relationship between these factors in depressed and non-depressed elderly. Materials and Methods: Cross sectional study was done on 46 depressed and 48 non-depressed elderly were assessed clinically and using Geriatric Depression Scale-Short form [GDS-SF], loneliness scale, and brief cope scale. Statistical analysis was done using SPSS 20 software. Result: Mean GDS scores, mean loneliness (emotional and social) scores of depressed patients were higher than that of non- depressed, and this difference was found to be statistically significant [GDS: t = 14.33, p<0.001, loneliness Score: t = 7.23, p<0.001]. Self-distraction (mal-adaptive-passive) was the most commonly used coping mechanism in depressed group, while in the non-depressed group active coping (adaptive) was most common coping mechanism. Loneliness (emotional as well as social subscale) was a significant predictor of depression in both depressed and non-depressed group (Beta = .714, p<0.001) and (Beta = .629, p<0.001) and predicted 51% and 39% variance in depression respectively. Loneliness appeared as a distinct factor which seems to have a temporal and synergistic relationship with depression. Use of more adaptive coping mechanisms is associated with decrease in loneliness and depression while use of maladaptive coping mechanism is associated with decreased depression and loneliness in elderly. Conclusion: Loneliness is an important distinct factor in predicting depression in elderly. Coping mechanisms used, also affects loneliness and depression significantly.

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Alcohol use typically begins in the adolescence and peaks over the adulthood. However, its abuse is not as uncommon among the elderly though it tends to be under.recognized. Certain age.related physiologic, biologic, and psychosocial issues pose unique challenges in the diagnosis as well as management of alcohol use disorders in the elderly. Indian studies. .. specifically focusing on elderly substance users. .. are few. Screening should be a crucial component during clinical encounters with elderly populations across a variety of settings. Depending on the extent, nature and pattern of use, the elderly persons may need less intensive, brief interventions to more intensive inpatient care for safety concerns. Emphasis should always be on age.specific treatments delivered by trained personnel using nonconfrontational approaches.

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There has been a steady rise in the prevalence of dementia all over the world. Our understanding of the illness, as well as its etiopathology, has also improved. Dementias due to degenerative and vascular pathology form the most common types of dementias resulting in cognitive impairment. However, these conditions usually lead to irreversible impairment and cause significant morbidity and mortality among patients. On the other hand, there is a group of conditions among elderly, where dementia follow a reversible course provided these conditions are picked and managed early. Few common causes of reversible dementias are Vitamin B12 deficiency, normal pressure hydrocephalus, thyroid dysfunction, anticholinergic medications, depression, etc. This review will discuss all these conditions with reference to their presentation, diagnosis, and management.

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Aims and Objectives: To determine the relationship between depression, perceived and received social support. Materials and methods: Forty elderly (age >60 yrs) subjects were assessed for depression and social support using Berlin Social Support Scale. Result: Significant negative correlation was seen between perceived social support and depression (r = −.413; P < 0.01). There was no significant correlation between depression and received social support. Conclusion: Perception of social support in elderly is affected by depression. Adequate treatment of depression which improves negative cognition would help in the perception of social support for elderly subjects who are depressed and aid in recovery.

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Background: The rising proportion of elderly in India exhibits concern for the well-being of this section of the population. It will be important to know what factors are responsible for elder abuse and also who commonly perpetuates abuse among elderly. Objectives and Aims: The objective of the study is to find out the prevalence of elder abuse and profile of abuser in Maharashtra. The study also tried to examine the differences in elder abuse cases by several socioeconomic characteristics, disability level, chronic conditions, and age cohorts. Materials and Methods: The data from the United Nations Population Fund survey named "Building Knowledge base of Population Ageing in India" was used. The sample size was 1435 respondents aged 60 and above. Cross-tabulation was done to assess the socioeconomic profile and elder abuse among elderly. Multivariate analysis named logistic regression was performed to know the important determinants of elder abuse and neglect. Results: Around 35% of elderly in Maharashtra had faced any abuse. The percentage of elderly who faced verbal abuse (30.1%) was highest, followed by economic abuse (22.5%) and physical abuse (18.0%). Neighbors (56.1%), sons (43.1%), relatives (38.6%), and daughter-in-law (31.9%) were involved in the majority of the abuse cases. Education, wealth quintile, living alone, and the presence of any disability and morbidity or injury were the important determinant of elder abuse. Conclusion: Elder abuse and neglect were quite high in Maharashtra. The policies and strategies need to form in order prevent abuse of elderly population in Maharashtra.

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Background: Depression in elderly is a public health problem. Aims and Objectives: To determine the prevalence of depression and its correlates among the elderly population. Materials and Methods: This cross-sectional study was conducted among elderly aged 60 years and above using two-stage cluster sampling technique among elderly residing in the rural and urban areas of Shimla district of Himachal Pradesh, India. A written consent was taken from each participant after explaining the purpose of the study. Results: Of the 800 subjects, 76 (9.5%) were found to be suffering from depression. The logistic regression analysis revealed that elderly having lower income, consuming tobacco, experiencing stressful life event in the past 1 year, having 3 or more chronic diseases, and lacking positive approach toward life and were found to be more depressed. Conclusion: The study conducted in Shimla district shows that one-tenth of the elderly residing in the study area suffering from depression. Elderly having lower income, residing in the urban area, experiencing significant life event, suffering from multimorbidity, and lacking positive approach toward life increase should be identified by screening. They should be focused on so as to reduce the probability of occurrence of depression.

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Psychotropic drugs are commonly used to manage mental and behavioral problems in geriatric patients. This is, however, accompanied by the risk of developing adverse drug reactions (ADRs), impacting the safety with which the drug can be used. In this article, we provide an overview of the factors associated with the ADRs due to psychotropic medication in the elderly, and the ADRs associated with the use of antipsychotics and sedative-hypnotics in the geriatric population. For this, literature searches were conducted through MEDLINE, PubMed, and Google Scholar using keyword terms: Geriatric, elderly, safety, adverse events, ADRs, antipsychotic, names of individual antipsychotics, benzodiazepine, sedative, hypnotic, zolpidem, zaleplon, zopiclone. Research data indicate that antipsychotics are associated with an increased risk of metabolic syndrome, thromboembolism, cerebrovascular and cardiac events, pneumonia, fractures, and increased mortality. Among antipsychotics, aripiprazole seems to have fewer ADRs while other antipsychotics (typical and atypicals) have reports of troublesome side effect profiles. Sedative-hypnotics are associated with a risk of falls, fractures, cognitive impairment, and may increase the risk of developing dementia with long-term use. The risk of these complications is present with both benzodiazepines and medications such as zolpidem and zopiclone.

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Aim of the Study: This study aims to evaluate the prevalence of physical comorbidities and prescription patterns in elderly patients with depression. Materials and Methods: This study included 488 elderly patients (aged ≥60 years) with depression recruited across eight centers. A self-designed physical comorbidity checklist was used to assess for the presence of various physical comorbidities and prescription of psychotropic medications was recorded. Results: More than three-fourth of the study sample (n = 384; 78.7%) had at least one physical comorbidities and one-third (36.7%) of the samples had at least three physical illnesses. About half of the study samples had hypertension (47.3%) and slightly more than one-fourth had diabetes mellitus (29%). The most common physical illness involved the cardiovascular system (51.5%), followed by endocrinological system (39.3%), orthopedic and joint-related diseases (35%), and ophthalmological problems (22.3%). Those with physical comorbidity had higher severity of depression, anxiety, and somatic symptom. Sertraline was the most preferred antidepressant followed by escitalopram and mirtazapine. Only 12.7% of the sample was prescribed antipsychotics of which quetiapine and olanzapine were the most commonly used agents. Benzodiazepines were prescribed to more than half of the study samples (56.55%), with clonazepam being the most preferred benzodiazepine followed by lorazepam. Compared to those without hypertension, those with hypertension were more commonly prescribed sertraline and escitalopram and less commonly prescribed fluoxetine. Similarly, compared to those without diabetes mellitus, those with diabetes mellitus were more commonly prescribed sertraline and less commonly prescribed fluoxetine. Conclusion: Comorbid physical illnesses are highly prevalent in elderly participants with depression with hypertension being the most common physical comorbidity followed by diabetes mellitus and osteoarthritis. The presence of physical comorbidity is associated with more frequent prescription of sertraline and escitalopram.

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Benzodiazepines belong to the hypnotic-sedative class of drugs which have anxiolytic, sedative, and hypnotic properties. These drugs have been in clinical use for at least half a century. The propensity for development of dependence, especially on prescription benzodiazepines, coupled with the risk of falls and cognitive impairment due to benzodiazepines makes the elderly population susceptible to adverse outcomes with the use of benzodiazepines, and hence, cautious use is desired in this population. This review discusses the various aspects pertaining to benzodiazepine abuse in the elderly including pharmacology, prevalence of abuse, adverse consequences of benzodiazepine abuse, and subsequently assessment and management of elderly patients with benzodiazepine abuse.

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Geriatric mental health has yet to receive its due recognition in India. Geriatric mental health is plagued by many challenges that prevent the development and progress of its services. The present article is a narrative review that looks at the various challenges faced by geriatric mental health in India. The article describes different specific and general unique challenges faced by geriatric mental health and discusses in detail the nature of each challenge and what must be done to overcome it. The challenges range from demography of Indian aging to sexual issues in the elderly, geriatric depression, dementia care, and the aging lesbian, gay, bisexual, and transgender community. Various issues related to policy and research that challenge geriatric mental health are also discussed. The need to incorporate geriatric mental health into primary health care along with the need to train primary care workers and preventive work aimed at suicide prevention in the elderly is stressed. The article addresses these challenges with the aim of positing before the clinician the various challenges faced by geriatric mental health in India in the current era.

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Aim: This study attempted to assess the incidence, prevalence, risk factors and outcome of delirium in elderly (≥60 years) patients admitted to a coronary care unit. Materials and Methods: Confusion Assessment Method for Intensive Care Unit (CAM-ICU) was used to screen the patients for delirium and those found to have delirium on CAM-ICU were subjected to a detailed evaluation by a psychiatrist to confirm the diagnosis of delirium. Additionally risk factors were assessed by using a checklist and outcome was determined. Results: One hundred and fifty two patients were evaluated for delirium. Of these, 37 (24.34%) patients had delirium at the first assessment (i.e. within 24 hours of admission in CCU) and were classified as 'prevalence cases' of delirium. Fifteen cases (13.04%) developed delirium after 24 hours of CCU stay and were considered as 'incidence cases' of delirium. Among the various risk factors studied, factors which were identified as predictors of delirium in binary logistic regression analysis were hypokalemia, Sequential Organ Failure Assessment (SOFA) score, use of warfarin, frusemide, ranitidine, benzodiazepine, opioids, steroids, more than 4/5 medications, presence of sepsis, cardiogenic shock, having undergone coronary artery bypass grafting, left ventricular ejection fraction <30, higher age, presence of uncontrolled diabetes mellitus and presence of congestive cardiac failure. Of the 52 patients who developed delirium, 10 (19.2%) died during their hospital stay, this was significantly higher than the mortality rate (1%) seen in the non-delirium group. Conclusions: In coronary care units, delirium is a common entity in elderly and is predicted by the presence of modifiable risk factors. Delirium is also associated with increased mortality.

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Aim of the Study: To assess the symptom profile of depression among elderly patients presenting to psychiatric outpatient settings. An additional aim was to evaluate the influence of gender, age of onset, age at presentation, and type of episode (i.e., the first episode versus recurrent depressive episodes) on symptom profile of geriatric depression. Materials and Methods: This multicentric study was conducted at eight centers in which 488 elderly patients (aged ≥60 years) with depression were evaluated on Geriatric Depression Scale (GDS-30), Generalized Anxiety Disorder-7 Scale (GAD-7), Patient Health Questionnaire-15 (PHQ-15) scale, and Columbia Suicide Severity Rating Scale. Results: Males had significantly higher prevalence of comorbid substance dependence, whereas females had significantly higher prevalence of comorbid psychiatric disorders. As per the GDS-30, about two-third or more of the study sample had symptoms of feeling helpless (71.7%), often getting restless and fidgety (70.1%), dropped many of their activities (68.4%), frequently feel like crying (67.4%), trouble concentrating (67%), feels pretty worthless (66.4%), often feeling downhearted and blue (65.8%), frequently getting upset over little things (64.8%), and not satisfied with life (62.9%). More than two-third of the sample had all the symptoms of anxiety as per the GAD-7 and 7 out of the 14 somatic symptoms as per the PHQ-15. When comparisons were made between males and females, significant difference in prevalence was noted for some of the depressive symptoms as assessed by the GDS-30 and somatic symptoms as assessed by the PHQ-15, but no differences emerged in terms of anxiety symptoms. Significantly higher proportion of females reported active suicidal ideation with specific plan and intent and had higher intensity of suicidal ideations. Differences in symptom profile were also noted with regard to age of onset (<60 and ≥60 years), age at presentation (<70 and ≥70 years), and type of depression (single versus multiple episodes). Conclusion: The present study suggests that somatic and anxiety symptoms are highly prevalent among elderly patients with depression. Further, it is evident that there are certain differences in the symptom profile of depression among male and female patients with depression. The present study also reveals that age of onset, age at presentation, and number of episodes could also influence the symptom profile of depression among the elderly.

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Background: Adherence to medical treatment is a major challenge. A significant proportion of patient's dropout of treatment after the initial visit. Little is known about the reasons for such high dropouts. Aim: This study aimed to evaluate the dropout rates and reasons for dropout from treatment among elderly patients with depression attending a tertiary care psychiatry outpatient facility. Methodology: One hundred and forty consecutive new patients aged 60 years or more, attending the psychiatry walk-in clinic, diagnosed with depressive disorders were assessed at baseline and then contacted at 6 months and 1 year to evaluate the follow-up status and reasons for dropout of treatment. Results: Out of the 140 participants, 132 could be contacted after initial registration with the clinic. About two-fifths (n = 58; 41.4%) never return back to the clinic after the first visit. By 6 months and 1 year, 105 (75%) and 126 (90%) patients had dropped out of treatment. When the reason for dropout of those who dropped out “very early (i.e., never returned back)” were evaluated, the most common reason for dropout was “no relief” of symptoms, and this was closely followed by complete relief of symptoms. Among those who followed up at least once, but had dropped out at 6 months, the most common reason for dropout was complete relief of symptoms, and this was closely followed by “no relief” and “worsening of illness” being the other common reasons of dropout. Among those who dropped out after 6 months, the most common reason for dropout was complete relief of symptoms. None of the demographic variable emerged as a predictor of dropout at any time point. Few clinical variables were associated with dropout of treatment. Conclusion: Very high proportion of elderly patients with depression dropout of treatment prematurely. Providing proper information to the patients at each visit can help in reducing the treatment dropout rates.

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Psychotropic-induced hyponatremia is one of the most common electrolyte abnormalities seen in routine psychiatric practice and is especially common in elderly subjects. Recent evidence suggests that even mild hyponatremia is associated with several detrimental effects in elderly. However, practicing clinicians often overlook hyponatremia due to lack of awareness about the incidence, presentation, and risk factors of psychotropic-induced hyponatremia. Available evidence suggests that all classes of psychotropics, i.e., antidepressants, antipsychotics, mood stabilizers, and sedative/hypnotics can lead to hyponatremia. Maximum evidence is available for antidepressant-associated hyponatremia. Various risk factors for hyponatremia include increasing age, female gender, low body weight, history of hyponatremia, low baseline sodium levels, summer season, initial phase of antidepressant use, early-onset psychiatric illnesses, longer duration of psychiatric disorder, prolonged admission, presence of comorbid medical conditions, concomitant use of diuretics, antihypertensives, and cytochrome P450 inhibitors. Awareness about this potentially life-threatening side effect and taking appropriate, timely steps can help in prevention of psychotropic-associated hyponatremia.

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Aim of the Study: This study aimed to evaluate the symptom profile, including somatic symptoms among elderly patients with first episode depression using the Geriatric depression scale (GDS-30) and Patient Health Questionnaire-15 (PHQ-15) items version scale. Additional aims were to carry out the factor analysis of symptoms reported on GDS-30 and PHQ-15 among elderly. Methodology: Seventy-nine elderly patients (age ≥60 years) were evaluated on GDS-30 item Hindi version and Hindi version of the PHQ-15. Results: As per GDS-30, the most common symptom noted among elderly was “dropped many of your activities and interests” (91.1%), mind not as clear as it used (88.6%), feeling that life is empty (86.1%), bothered by thoughts you cannot get out of your head (86.1%) and hard to get started on new projects (86.1%), prefer to avoid social gatherings (86.1%). All patients reported at least one somatic complaint as per PHQ-15. The most common somatic symptoms were trouble sleeping (97.5%), feeling tired or having little energy (96.2%), feeling that the heart is racing (52.9%), constipation, loose bowels, or diarrhea (49.6%), shortness of breath (46.8%), nausea, gas or indigestion (45.6%), pain in the arms, legs, or joints (43.3%), and back pain (41.8%). The prevalence of somatic symptoms was not influenced to a large extent by the demographic variables, clinical variables and presence or absence of physical comorbidity. However, the severity of somatic symptoms correlated positively with GDS-30 score. Factor analysis of Hindi version of GDS-30 yielded a four-factor solution, which was similar to many studies across the world. The addition of items of PHQ-15 items of factor analysis still yielded a four-factor solution. Factor 1 of combined GDS-30 and PHQ-15 items included items only from GDS-30 and Factor 3 and 4 included items only from PHQ-15. There was some overlap of items on Factor 2. Conclusion: The present study suggests that GDS-30 does not tap all the symptoms of depression among elderly in the Indian context. Further, the present study shows that GDS-30 is not a one-dimensional scale. Accordingly, the symptom evaluation among elderly depressed patient should go beyond GDS-30.

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Background: Geriatric population is on a steady rise since the past decade especially in densely populated countries like India. Elderly form a significant proportion of patients presenting to the medical emergency department and they warrant more attention in terms of mental health conditions as they are more predisposed to conditions such as delirium and cognitive impairment. Aim of this Study: This study aimed to evaluate the prevalence of psychiatric morbidity including substance use disorders among elderly (age ≥60 years) presenting to emergency medical outpatient services. Methodology: A total of 300 patients aged 60 years and above attending the medical emergency department of tertiary care hospital were approached, out of which, 232 participated. All the patients were assessed by Confusion Assessment Method, Modified Mini Screen and Alcohol, Smoking, and Substance Involvement Screening Test. Those found positive on any of the screening instrument were further evaluated on International Classification of Diseases-10 criteria, by a semi-structured interview to confirm the psychiatric diagnosis. Results: At least, one psychiatric diagnosis, i.e., either axis-I psychiatric disorder or substance dependence disorder was seen in 62% of cases. Nearly, half of the patients (47.4%) fulfilled at least one axis-I psychiatric diagnosis other than the substance dependence disorder at the time of assessment, with delirium being the most common, seen in about one-third (34.1%) of the participants. Other psychiatric diagnoses in the study sample included dementia (9.5%), depressive disorders (8.2%), adjustment disorder (3%), and anxiety (not otherwise specified) disorder in 3.4% of participants. About one-third (31%) of the participants had tobacco dependence, currently, using and one-fifth (19.8%) of patients had alcohol dependence syndrome currently using. Higher prevalence of delirium and dementia was noted among patients who were aged ≥70 years. Conclusion: The present study shows that elderly patients presenting to medical emergency department have a high prevalence of psychiatry morbidity. Accordingly, there is a need to reorganize psychiatric services and training to improve the identification and management of mental disorders among elderly patients presenting to emergency.

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Reminiscence therapy (RT) has been used over the past two decades extensively in the management of patients with dementia and geriatric depression. The following review study looks at the current role of RT in geriatric patients from a clinical perspective. The review elucidates the concept of reminiscence and looks at the historical aspects of RT. It also looks at the taxonomy and classification of the various types of reminiscences and RT techniques. The difference between reminiscence and life review is discussed. There are sections that look at the clinical role of RT in the management of patients with dementia and geriatric depression. The role of art therapy as a form of RT is discussed and elaborated. The existing literature on RT is reviewed, and certain recommendations for RT are made. There is also a slight deliberation on the need for RT in Indian settings. The role of RT as positive geriatric mental health intervention is also discussed.

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Background: Medically ill elderly patients are more prone to develop depression. Faulty coping mechanisms increase the risk of developing depression. Spirituality is known to decrease this risk. Aim: This study was conducted to assess the prevalence of depression in medically ill elderly patients, coping strategies used and spirituality as a way of coping. A comparison was made between coping strategies used by depressed and nondepressed elderly patients with medical illnesses. Materials and Methods: This was a cross-sectional study carried out at a tertiary care hospital. A total of 100 consecutive patients were evaluated on Geriatric Depression Scale, Coping Inventory for Stressful Situations-21, and Spiritual Attitude Inventory. Results: Prevalence of depression was 72% among the medically ill elderly patients. Of those found to have depression, two third had mild depression and one-third had severe depression. On comparing coping and spirituality between depressed and nondepressed patients it was found that non depressed patients had better coping towards stressful situation, they used more of task oriented and avoidance based coping, whereas depressed patients used more of emotion oriented coping. Non-depressed patients were more spiritual when compared to depressed patients. Severity of depression positively correlated with emotion oriented coping mechanisms and it was negatively correlated with task and avoidance oriented coping mechanisms and spirituality in all four domains. Conclusion: The present study shows that 72% of medically ill elderly patients have depression and compared to those with one medical illness, the prevalence of depression is more among those who have 2 or more medical illnesses. Compared with those without depression, patients with depression more often used emotion based coping, less often used task and avoidance coping mechanisms and were less spiritual.

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